Correlation Analysis Of Hyponatremia With Clinical Characteristics And Prognosis Of Advanced Non-small Cell Lung Cancer

ObjectiveHyponatremia is a common electrolyte disorder in cancer patients and a contributing factor to poor prognosis,especially in small-cell lung cancer（SCLC）.However,there are few studies on hyponatremia and non-small cell lung cancer（NSCLC）,so this study aimed to analyze the relationship between initial hyponatremia at diagnosis and clinical features of advanced NSCLC and whether it can predict the prognosis of advanced NSCLC.MethodA systematic review of patients with stage IIIB-IV NSCLC admitted to the Department of Respiratory Medicine,First Hospital of Lanzhou University from January 1,2017 to June 30,2021 was conducted.A total of250 patients were selected according to inclusion and exclusion criteria and divided into hyponatremia group and normal blood sodium group according to their initial serum sodium level at diagnosis.General demographic characteristics,clinical symptoms,pathological features,test indicators and other data were collected,the overall survival of patients was followed up,and the chemotherapy efficacy of 71 patients whose first-line treatment regimen was 2 cycles or more two-drug chemotherapy containing platinum was collected.To investigate the correlation between hyponatremia and clinical features of advanced NSCLC,and whether it affects the efficacy of chemotherapy and overall survival（OS）.Results（1）In the 250 patients with advanced NSCLC collected in this study,the serum sodium values ranged from 123-145mmol/L,which were divided into normal blood sodium group and hyponatremia group with ≤135mmol/L as the cut-off point.There were 176 cases in normal blood sodium group,accounting for 70.4%,and 74 cases in hyponatremia group,accounting for29.6%.Patients with mild,moderate and severe hyponatremia accounted for 24.4%（61/250）,4.4%（11/250）and 0.8%（2/250）,respectively.（2）Compared with normal serum sodium group,advanced NSCLC with hyponatremia group was more likely to be older,higher TNM staging,merging pleural effusion,bone metastases,obstructive pneumonia,anemia and hypoalbuminemia.Lactate dehydrogenase,white blood cells,neutrophils,monocytes and platelet levels were higher than normal serum sodium group,the difference was statistically significant.（3）Logistic regression analysis showed that complicated pleural effusion,obstructive pneumonia,hypoproteinemia and elevated neutrophil levels were independently associated with hyponatremia in advanced NSCLC.（4）Among the 250 patients with advanced NSCLC included,71 patients received two or more cycles of platinum-containing two-drug chemotherapy as first-line treatment.Binary Logistic regression analysis showed that hyponatremia was an independent risk factor for disease progression in patients with advanced NSCLC after two cycles of chemotherapy.（5）Univariate analysis showed that OS was not associated with BMI,tumor differentiation,pleural effusion,bone metastasis,or obstructive pneumonia,but was associated with gender,age,smoking status,pathological type,TNM stage,hyponatremia,anemia,hypoproteinemia,and platelet level,with statistically significant differences.COX multivariate regression analysis showed that hyponatremia was an independent adverse factor affecting OS in patients with advanced NSCLC,in addition,age and TNM stage were also independent influencing factors.（6）The median overall survival（m OS）was 346 days in the hyponatremia group and 649 days in the normal blood sodium group,with statistically significant differences.The 1-year survival rate of the hyponatremia group was 0.461,and that of the normal blood sodium group was 0.708,the difference was statistically significant.（7）Subgroup analysis of other two independent influencing factors of advanced NSCLC,age and TNM stage,showed that m OS in the hyponatremia group was shorter than that in the normal blood sodium group,and the difference was statistically significant.Conclusion（1）Patients with advanced NSCLC complicated with pleural effusion,obstructive pneumonia,hypoproteinemia and elevated neutrophil levels are more likely to be complicated with hyponatremia.Monitoring of serum sodium level in these patients should be strengthened.（2）Hyponatremia is an independent risk factor for disease progression after 2 cycles of chemotherapy in advanced NSCLC.（3）Hyponatremia is an independent adverse factor affecting the overall survival of patients with advanced NSCLC,and can be used as an indicator of prognosis.In addition,age and TNM stage were also independent factors.